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runbikestent

Me a diabetic? Are you crazy?

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runbikestent

Hello all,

 

Here is my story.  Like many of you here, I just found out that I am a Type 1.5.

 

Here is my story.  I just turned 51, so I figured I should go in and see my doc and the usual run of labs and get scheduled for a colonoscopy which I didn't do last year.

 

Imagine my surprise when my doc called me to tell me that my fasting glucose was 119.  Lets get some other tests, he tells me. 

 

Hb A1c :  6.2

C peptide:  .077

GAD AB:  Less than 5 (normal)

ANA:  Negative

IA-2 antibody:  <0.8 (normal)

Insulin Autoantibody:  <0.4 (normal)

 

By way of background, I am very fit.  Resting heart rate of 42, competitive ironman triathlete and runner. Body fat less 8%.  No health issues ever.

 

And oh by the way, I too am a physician.  I am a cardiovascular interventional, and treat diabetics every single day of my life.

 

Here to get educated by you all!

 

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dowling gram

Hi and welcome to the forum. A Doctor--um--I wish more of your profession would learn from us.

 

Diabetes is no respecter of fitness or weight. You can be physically fit, have normal weight and generally be in excellent health and still get diabetes.

 

After my diagnoses my first thought was what am I going to do about it. I found this site and a lot of knowledgeable people who live with diabetes every day and have found out how to lessen the impact of the condition. The first thing you have know is diet plays the biggest part in keeping your blood glucose under control. Meds and insulin play a part but without cutting carbohydrates you won't have success. I keep my carb intake to 60 g per day and that keep my A1C BG under 6. The best thing you can do is read Dr. Bernstein's book--diabetes solution. He is old now but he has lived a long life with type 1 diabetes since childhood and his book tells you how he did it.

 

Stick around and do some reading and ask any questions you may have. We are a friendly bunch here to help.

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runbikestent

Yup.  Here to learn.  I will read Dr. Bernstein's book.

 

Thanks

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samuraiguy

Welcome to the forums. Unfortunately just aging can trigger either type 2 or type 1.5 regardless of other risk factors, fortunately adopting lifestyle changes can manage both.

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NoraWI

Welcome to DF! I disagree that T1.5 (LADA) is triggered by aging. T1.5 shows itself in later years. LADA is a slow onset adult T1 where the body has been fighting off the autoimmune attack, sometimes for decades, and finally succumbs when the number of beta cells have decreased to the point where blood glucose numbers begin to rise. The cause can be a past infection or genetic predisposition. We do not know. But here it is. And here you are. However, diatary changes as well as insulin are the order of the day because T2 medications will not work and we do want to preserve as many remaining beta cells as we can. Do read Dr. Richard Bernstein's "Diabetic Solution." He is old but he has always been wise. His own T1 story is amazing. By testing his glucose levels and eating low carb, he has brought himself from a complications riddled youth to a relatively healthy old age. I find him to be a bit extreme, but truly inspirational. And, I might add that I, too, wish more doctors would join our DF community and learn from those who live it every day.

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Uff Da

Welcome to DF. Sorry to hear of your diagnosis.

 

I'm a little confused about your diagnosis, though. On what basis did your doctor diagnose type 1.5 or LADA? You do have a low c-peptide, but not low enough to usually be diagnosed as a type 1 by the scales I've seen, without also testing positive to any of the antibodies, as well. Perhaps the lab used a different scale. I'm no doctor, though, and there is a lot I don't know about the complexities of diabetes diagnosis, which is an evolving thing. But so many of us have trouble getting the right diagnosis and are diagnosed as type 2 for months or years.

 

In my case, I presented with a FBG of 289, confirmed with an A1c of 11.5 just 13 months after a normal FBG. But because I was age 70 at the time, I was diagnosed as type 2 and put on a diet, which contained more carbs than I was accustomed to eating. My postprandial shot up to 548 two days in a row. I quickly abandoned her diet. She put me on type 2 drugs, but I still had to eat low carb and low calorie to get my blood glucose within reason. I got down to 106 pounds from my original low-normal weight of 122 before I decided I just couldn't lose any more weight and would have to increase carbs and let my BG rise. My doctor would still not do the antibody tests or refer me to an endo. Finally when the A1c rose again to 7.6, a year and a half after initial diagnosis, she referred me to an endo, who diagnosed me with adult onset type 1 on the basis of high GAD65 and high IA-2. If you stick around, you'll read many stories of others who had similar difficulty of being diagnosed with type 1 as an adult.

 

I agree with the Dr. Bernstein book recommendation given by dowling gram above. If you aren't on insulin yet, you might be able to hold off going on insulin quite a while by just following Bernstein's diet recommendations. As an athlete, however, you may find it too extreme and need to make your own adjustments to the diet. Since I'm on insulin now, I'm simply not willing to eat that low carb, but eat around 120-150 carbs most days. However, those extra carbs mean a lot higher variability in BG. I'd have a lot fewer highs and lows if I were willing to go lower carb.

 

 

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meyery2k

Doctor - Welcome!

 

I believe you will not get better help than you would here.  You can also make some fine friends.  I was diagnosed as a T2 1 year ago.  I somehow found this forum.  Like you, I believed people that live with this would be able to better help me than theory. 

 

I have been very fortunate because I can manage with diet and exercise. 

 

Wow - you are a triathlete!  Impressive.  Last year, I couldn't walk up 3 flights of stairs without getting winded.  I used diabetes and the regimen it brought upon me to turn a lot of things in my life around.  While I am no triathlete by any means, I run, cycle, swim, and walk.

 

I live in Hilo, HI.  Have you participated in the Ironman? ~ Mike

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Kit

Welcome to DF. Sorry to hear of your diagnosis.

 

I'm a little confused about your diagnosis, though. On what basis did your doctor diagnose type 1.5 or LADA? You do have a low c-peptide, but not low enough to usually be diagnosed as a type 1 by the scales I've seen, without also testing positive to any of the antibodies, as well. Perhaps the lab used a different scale. I'm no doctor, though, and there is a lot I don't know about the complexities of diabetes diagnosis, which is an evolving thing. But so many of us have trouble getting the right diagnosis and are diagnosed as type 2 for months or years.

 

I wondered the same myself.  A T1 diagnoses without antibodies seems odd to me.  But I'm not an expert on the subject so . . .

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NoraWI

There are several different kinds of antibodies. Not all are commonly tested for. As a matter of fact, most doctors are reluctant to test for ANY antibodies unless really pressed. Don't really know why unless they sustain some kind of loss for ordering the expensive tests. But being T1 or T2 or other kinds of diabetic (which there are) does make a difference in treatment.

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mystiquarte

Hi Doc welcome to the forums :)
I am sorry to hear of your diagnosis but sometimes there is an underlining 'good' to come from bad news; that is how things have worked out for me I have a blog which your welcome to check out.  I was diagnosed two years ago and went into denial and stayed there until I had surgery last June and it was at that point I turned everything around.  The staff in the hospital gave me insulin and I felt better than I had for a long time, saw my Endo in August and started my byetta and lantus and I'm due for my 2nd appt with him soon.  As you probably already know, there isn't a solution that 'fits' everyone diabetes doesn't work like that you have to trial and error to find what works for you.

let us know how your getting on and if you have any probs along the way there is always someone here.  
good luck :)

 

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runbikestent

Thanks for all of the encouragement folks.

 

As far as my active lifestyle, I have been an endurance athlete for years, time permitting.  I can run 20 miles without needing much fuel.  I recently finished 1st in my age category in a medium size race.  All these years I have been exercising to set an example to my staff and patients of the importance of exercise.  Funny to find myself here.  I think perhaps divine intervention? with Him wanting for me to  have more sympathy for my patients with DM.

 

I am signed up for a full Ironman Triathlon in November of 2017, before the shocking news.  I don't even know how to adjust my intake of carbs to my level of training.  I will have to do extensive reading and research.  I will often burn 1500 or more calories in a single workout, all carbs.  How do I replenish on a low carb diet?  Lord knows.

 

Anyways, I digress.

 

My doctor, also a friend and colleague is calling it prediabetes 1.5.  He was pleased that the autoimmune workup was negative, though that does not mean that it isn't.

 

I think he is leaning toward Metformin or low dose insulin already.  But I am not quite ready for that yet.  I want to do the diet thing.  Can't exercise any more than I do, and I can't lose any weight, as I am already a stick figure.

 

I spent much of the day reading and shopping for stuff, such as a glucose monitor and trying to sort out what this all means.  Unhappy sad wife, who is also shocked, and this on the heals of our beloved dog of 15 years who passed last week.

 

rough week.

Thanks!!

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adiantum

My condolences over the grief of saying goodbye to your friend. 15 years was a good innings & many memories of memories  are yours to cherish.

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lklacy56

I think you will find some of Professor Noakes works to be something you might enjoy. If you are looking to compete and fuel your body with fat instead of carbs. 

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miketurco

I think there are two majoe differences between what most doctors tell their patients vs. The advice that diabetics share with one another. The first is sugar levels. Most of "us" shoot for an a1c six or less, and there quite a few of us in the 5's club. Second thing is diet. Low carb mostly, although some fate well on 100g or more per day.

 

Eating too many carbs and compensating with insulin is a Rollercoaster rode to heck.

 

The ideal goal is normal blood sugars. Many people are able to mostly/usually do that. For many others is totally unrealistic.

 

Finally, be careful when you drink. Alcohol can shut down the liver in terms of producing sugar. Carry candy arty all times and be ready to use it when you're drinking.

 

My .02, anyway.

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stevenal

Glad we got the diagnosis straightened out. 1.5 means something completely different to most of us.

 

There does seem to be evidence that metformin can halt the progression, so you may wish to give it a try. It's pretty benign stuff, perhaps a bit of digestive upset to begin with. They are saying it might increase the longevity of even non-diabetics.  

 

Definitely skip the insulin. It's the overexposure to a substance that causes resistance to that substance. Search here for LCHF for some diet tips.

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Kit

There are several different kinds of antibodies. Not all are commonly tested for. As a matter of fact, most doctors are reluctant to test for ANY antibodies unless really pressed. Don't really know why unless they sustain some kind of loss for ordering the expensive tests. But being T1 or T2 or other kinds of diabetic (which there are) does make a difference in treatment.

 

The first posts mentions all 4 antibody tests that I am aware of which all came back as normal.  I'm just curious as the definition of Type 1 (or 1.5 for that matter) is an autoimmune attack, which required antibodies.  Now a long term Type 1 might not have much show up in blood tests if the beta cells have been completely killed off, but with the numbers the OP is getting, that obviously is not the case or he would be way higher.

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runbikestent

I think you will find some of Professor Noakes works to be something you might enjoy. If you are looking to compete and fuel your body with fat instead of carbs.

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runbikestent

I think you will find some of Professor Noakes works to be something you might enjoy. If you are looking to compete and fuel your body with fat instead of carbs. 

I will definitely look into it.  I ran 8 miles this morning before work and felt so hungry all day. 

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runbikestent

The first posts mentions all 4 antibody tests that I am aware of which all came back as normal.  I'm just curious as the definition of Type 1 (or 1.5 for that matter) is an autoimmune attack, which required antibodies.  Now a long term Type 1 might not have much show up in blood tests if the beta cells have been completely killed off, but with the numbers the OP is getting, that obviously is not the case or he would be way higher.

 

I am not educated on the subject enough to the exactly the story.  I will probably sit down with an endocrinologist sometime soon.  All of you know have me a bit scared that the endocrinologist might feed me a bunch of bull.  I know, I am a doctor too, but I can be skepitcal too can't I?

 

I am leaning towards Metformin at the moment.

 

I am so amazed at the fortitude you all have, and the courage.

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miketurco

Sounds like you have T2 not T1. Many people think that being overweight, in many cases, is the cause of T2 diabetes. I think it's the other way around. The body becomes insulin resistant, asks and asks and asks for more carbs and that's what packs on the pounds. If you weren't so active, that could have been the case for you. (Just thinking out loud...) 

 

Will be interesting to see if and if so how your perspective on d changes over time. I'm wondering whether you're a low-fat, whole grain, statin prescribing, stent recommending, whole wheat/skip the meat, ADA/AHA guideline pushing kind of doctor. Or more of an anti-establishment fish oil, vitamin D, low-carb "eat three eggs, skip the toast, play 52 pickup three times a day and call me in the morning" kind of guy. Have you read any of Taubes's books? Read the spacedoc site? Dr. Fung? Forks over knives? (GAH!) Ah well... in any case, good to see a doctor here -- lot of good info here, lot of good people too. As to "courage," it's either that or masochism. Getting your numbers in order and keeping them there takes a lot of finger poking. -- Mike

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jwags

I am 112 pounds and very diabetic. Before Diabetes I worked out in the Gym or on the tennis courts 2-3 hours most days. I ate a mostly vegetarian diet and still became diabetic. I do think there is this misinformation out there that Diabetes is only caused by being overweight,mit is not, I had Antibodyntests done and they were Negstive but my c-peptide is on the low normal side. So I don't produce a ton of insulin. I take the max of Metformin and Januvia.

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GrammaBear

I am not educated on the subject enough to the exactly the story.  I will probably sit down with an endocrinologist sometime soon.  All of you know have me a bit scared that the endocrinologist might feed me a bunch of bull.  I know, I am a doctor too, but I can be skepitcal too can't I?

 

I am leaning towards Metformin at the moment.

 

I am so amazed at the fortitude you all have, and the courage.

 

From my own personal viewpoint, there are different types of Endocrinologists.  I've had the misfortune to see some that definitely have a closed mind and will not vary from the high carb, low fat approach to eating.  Then again I've had the privilege to see an Endocrinologist that sat and listened first to my questions and then offered me his own personal advice - off the record - for a healthier way of eating which for him was low carb, high fat.  Your best bet is to listen to an Endocrinologist and then make up your own mind as to what is best for you.  Eat to your meter which means if you find a certain food gives you numbers way above your target, stay away from that food.  Good Luck to you and Welcome to this forum.

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